5703Long-term outcome of total arterial myocardial revascularization versus conventional coronary artery by-pass in diabetic and non diabetic patients: a propensity-match analysis
Bibliographic record
Abstract
Introduction: Evaluate with a propensity match comparison the long-term outcome of patients with and without diabetes undergoing total arterial versus conventional myocardial revascularization. Purpose: Primary end-point were survival freedom from all-cause death and cardiac-related mortality while secondary end-point was the occurrence of MACCEs (defined as cardiac death, myocardial infarction, repeated revascularization on grafted vessels, stroke). Methods: Study population included 1000 consecutive patients underwent CABG surgery for double or triple vessel disease. We performed a propensity-match analysis in order to compare patients receiving total arterial grafting (G1,618 pts.) with patients receiving conventional myocardial revascularization by means of LIMA on LAD plus saphenous vein grafts (SVGs) (G2,382 pts.). Following propensity matching two homogeneous groups of 359 patients each were obtained. Results: There were no significant differences between the groups in terms of pre-operative continuous and discrete variables and risk profile (SYNTAX score: G1 23.9±8.6 vs G2 24.7±7.9, p=0.364) nor where there any differences in terms of number of grafted vessels (G1= 2.63±0.43 vs G2=2.62±0.6; p=0.41). CPB duration was significantly longer in G2 (G1 61 min vs G2 87 min) because of the time needing for proximal anastomosis. There were no differences between the groups in terms of 30-day mortality (G1: 0 pts vs G2: 1 pts, 0.3%, p=0.91) and major peri/post-operative complications. At a median follow-up of 101 months (range 11–185 months), total arterial grafting was associated with significantly better overall survival (G1= 76.5; 95% CL: 73.5–79.5% vs G2=66.0; 95% CL 62.9–69.1%; p<0.001), survival freedom from cardiac death (G1= 90.8; 95% CL: 88.7–92.9% vs G2=84.2 95% CL: 82.3–86.1%; p=0.043) and occurrence of MACCEs (G1=80.1%; 95% CL: 76.9–83.3% vs G2=70.8; 95% CL: 67.9–73.7%; p>0.001). Diabetic patients receiving total arterial revascularization showed a significant better outcome when compared to those receiving saphenous vein grafts in terms of freedom from cardiac death (G1: 84.7; 95% CL: 82.6–86.7% vs G2: 79.3; 95% CL: 76.9–81.7%; p=0.035) and freedom from MACCEs (G1: 77; 95% CL: 71–83% vs G2:53; 95% CL: 47.2–58.8%; p<0.001). Multivariate Cox regression analysis identified Diabetes (HR=1.94, CI 95%=1.12–2.93; p<0.001) and the use of saphenous vein grafts (HR=1.81, CI 95%=1.32–2.65; p<0.001) as independent predictors for all-cause death. In diabetic patients Cox regression analysis identify the use of saphenous veins graft as the strongest independent predictor of MACCE (HR=2.41, CI 95%=1.27–4.59; p=0.007) and cardiac death (HR=3.24, CI 95%=1.69–6.23; p<0.001).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".